Summary Positive Clinical Behavioural Therapy (202200077)
Course followed from April 2023 till June 2023 @ university of Twente
Part of the master positive clinical psychology & technology
This summary includes all exam material for this course
Pay in mind, some notes about this summary.
- Bannink book: chapter 3, 4, 6 & 7 are not summarized completely1
- Bannink book: chapter 8 till 17 are not included2
- Kennerly book: chapter 3 & 5 till 19 are not included2
- Kennerly book: chapter 3 & 7 till 15 are included in another summary3
- Lang Article: not summarized completely1
1:
As not all pages are exam material, which pages are summarized, is included below
2:
As this is not exam material
3:
See the summary called “complete summary of the books for the course positive clinical psychology” on my
Stuvia account (myrthevandenhazel)
Book: practicing positive CBT from reducing distress to building success (by Bannink, 2012, 1st edition)
Book: an introduction to CBT skills and applications (by Kennerly, Kirk & Westbrook, 2016, 3rd edition)
Book positive CBT
- Part I theory: chapter 1: What is CBT? Page 2
- Part I theory: chapter 2: What is positive CBT? Page 3
- Part I theory: chapter 3: Possibilities of positive CBT (page 19 – 23) Page 8
- Part I theory: chapter 4: Two positive sources (page 34 – 41) Page 10
- Part II: applications: chapter 5: Enhancing the therapeutic alliance. Page 14
- Part II applications: chapter 6: Assessment (page 77 – 95) Page 20
- Part II applications: chapter 7: Changing the view (page 99 – 115) Page 29
Book introduction to CBT
- Chapter 1: Basic theory, development, and current status of CBT Page 37
- Chapter 2: Distinctive characteristics of CBT Page 44
- Chapter 4: Assessment and formulation Page 48
Articles
- Lang (1998): measuring emotions (page 655 – 666) Page 61
- Kuyken (2008): case conceptualization Page 68
- Brewin (2006): cognitive therapy Page 72
1
, Book practicing positive CBT (Bannink, 2012). Part I theory
Chapter 1: What is CBT?
Introduction
CBT = psychotherapeutic approach, talking therapy
Roots lie in 1920s, 1960’s (development behavioural therapy) and the merging of the two.
Therapy assumes that maladaptive behaviours and disturbed mood or emotions are the result of inappropriate or
irrational thinking patterns (automatic thoughts).
Behavioural therapy trains client to replace undesirable behaviours with healthier behavioural patterns,.
It does not focus on uncovering/understanding the unconscious motivations.
Goal = help clients bring about desired changes in their lives.
Objective = identify irrational/maladaptive thoughts, assumptions and beliefs that are related to debilitating
negative emotion + to identify how they are dysfunctional, inaccurate or not helpful.
Initial sessions: usually spent explaining the basic tenets of CBT + establishing working relationship
CBT = collaborative, action oriented therapy effort. It empowers the client by giving him an active role.
Positive alliance + empirically supported treatment methods enhance therapy outcome.
- Goes two ways
- Positive alliance increases potential of effectiveness of methods
- Using effective methods leads to a more positive alliance
CBT techniques
To help uncover and examine thoughts + change behaviour
- Clients keep diary of thoughts, feelings and actions. Helps to make them aware of maladaptive thoughts
+ helps to show consequences. It may serve to demonstrate and reinforce positive behaviours.
- Cognitive rehearsal (imaging difficult situation and dealing through it in imagination). Clients rehearse
steps mentally.
- Testing of validity of automatic thoughts and schema’s (to exposure faulty nature of schema)
- Modeling (role play)
- Conditioning = reinforcement to encourage a particular behaviour.
- Systematic desensitization = imagination of a situation and learning techniques to relax, rope and
eventually eliminate the anxiety. The imagination becomes more and more intense to the eventual
feared stimulus (graded exposure).
- Relaxation, mindfulness, distraction techniques
- Mood stabilizing medication
- Homework assignments.
Empirical evidence
Empirical evidence that CBT = effective (sometimes even preferred over other therapie forms)
- Mood disorders
- Anxiety disorders
- Personality disorders
- Eating disorders
- Substance abuse disorders
- Psychotic disorders
CBT = often manualized, specific technique driven, brief, direct, time limited, problem focused, structured
CBT = offered as individual & group therapy
Focus can be either more cognitive or behaviorally oriented.
CBT can be seen as a class of treatments, which have the same features in common but also differ in important
respects.
2
, Book practicing positive CBT (Bannink, 2012). Part I theory
Chapter 2: What is positive CBT?
Introduction
According to traditional model: first find out what is wrong, then formulate correct diagnosis, then remedy
provision. In short: diagnosis + prescribed treatment = symptom reduction.
- Useful in simple cases
- Major disadvantage: very problem focused. If the problem and its causes are studies in depth, a vicious
circle may develop in which everything becomes a problem.
o Psychology became a victimology in this view
o Psychologists became pathologizers
- !! exploring / analyzing the factors that cause / perpetuate a problem does not automatically result in an
improvement of the problem
- However, medical model is still most widely used.
o This affects people negatively
o This medicalizes people
o Using this model lead to high % of stress, depression, suicide, burnout and secondary
traumatization in health care workers.
Shortcoming of problem-solving paradigm
Traditionally: focus is on pathology & diagnosis is 1st step > finding causes 2nd step (= called cause effect model,
medical model, mechanical model).
Model is very straightforward: identify cause and remove it. It makes sense, but is inadequate for a number of
reasons
- We are never able to isolate one cause in a complex situation
- Danger in focusing on one cause, because then we ignore the rest of the situation
- Sometimes we cannot remove the cause
- False notion that when cause is removed situation becomes resolved; this is often not the case
In positive CBT we set out to design something, there is an output, there is something to achieve. This is an
example of outcome analysis or goal analysis.
De Bono: we need to design outcomes (and not solutions, because this word implies there is a problem)
Lambert and Ogles: there is a growing dissatisfaction among clients and professional with the use of problem
focused models.
Exercise 2.1.
Consider a typical problematic situation. Write down the typical questions you ask yourself or others about it. Examine
these questions closely. Does asking them help you feel better or worse? Does asking them help move you forward to
where you want to be or merely give you an explanation for why you are stuck or can’t change? If your questions are not
helping you, find some more helpful questions.
Story 2.1. how not to be unhappy.
The ancient Greeks already faced the choice between “how not to be unhappy” or “how to be happy.”The Stoics (third
century BC: Zeno, and later Seneca and Epictetus) practiced discomfort and difficulty; their aim was not to be unhappy.
Today the word “stoic” commonly refers to someone indifferent to pain, pleasure, grief, or joy.
Epicurus was another ancient Greek philosopher (second century BC) and the founder of the school of philosophy called
Epicureanism. For the Epicurists the objective was to attain a happy, tranquil life, surrounded by friends and living self-
sufficiently.Their aim was to be happy.
As we face the same dilemma today, we can also let our clients decide what they would prefer: how to not be unhappy or
how to be happy. In Chapter 6, I will elaborate further on these so-called approach goals (to be happy) or avoid- ance
goals (to not be unhappy).
3
, Towards a strengths and solutions paradigm
Strength based approach (with roots in positive psychology) may be the answer to the bad nieuws
- This is a meta view
- Overaching philosophical perspective in which people are seen as capable and having the abilities and
resources within themselves and their social system.
o When this is activated and integrated with new experienceds and skilss, srengths offer
pathways to
§ Reduce pain and suffering
§ Resolve concerns and conlifct
§ More effectively cope with life stressors
o Outcome = improved sense of wellbeing and quality of life
o Outcome = higher degrees of interpersonal and social functioning
Strengths based approach follows the basic assumptions (Saleebey)
- Everybody possesses strengths that can be used to improve quality of life
- Client motivation is increased by a consistent emphasis on strengths as the client defines them
- Discovering strengths = cooperative exploration
- Focusing on strengths turns therapists away from the temptation to judge or blamed clients for their
difficulties
- All environments – even the most bleak – contain resources
Exercise 2.2.
Sit comfortably, close your eyes and repeat the following sentence ten times: “I have a big problem!” Observe closely
what you are experiencing physically and emotionally. Notice carefully the effect that this sentence has on your body and
on your emotions.
Stretch a little, get up and do the exercise again. Set yourself comfortably again, close your eyes, and then repeat the
following sentence ten times: “I have a great opportunity!” Once again, observe the effects that this sentence has on your
physical and emotional state.
Kuyken: most important outcomes for clients are
- Attaining positive mental health qualities such as
o Optimism
o Self confidence
- A return to noes usual normal self
- A return to usual level of functioning
- A relief from symptoms
Kuyken advocates for including strengths in CBT.
- Strengths = attributes about a person such as good coping abilities or protective circumstance such as a
supportive partner
- Resilience
o = broad concept that refers to how people negotiate adversity to maintain their wellbeing. It
described the psychological processes through which people draw on their strengths to adapt to
challenges.
o = the processes whereby these strengths enable adaptation during times of challenge
o = differentiated from strengths (shown by Masten)
When there is focus on strengths, these strengths can be incorporated into conceptualizations to help understand
client resilience. When focus is on problems, there will be less relisience.
In positive CBT: there is a shift of focus of attention FROM analysis, explanations and problems TO thoughts,
actions and feelings that can help clients flourish. This takes three steps
1. Aknowledge the problem of the client (this must be hard for you)
2. Suggest desire for change (I guess you would like things to be different)
3. Ask about desired outcome
!! getting rid of unhappiness, is not the same as gaining happiness!!
Think about two continua model of mental health for example
4
